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Goals of O2 therapy
- Relieve hypoxemia - PNA,V/Q mismatch
- Decrease WOB - asthma,COPD
- Decrease work of heart -MI,pul edema
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O2 induced hypoventilation
Complication O2 therapy in patient who breaths on hypoxic drive (COPD)
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Signs of O2 induced hypoventilation
- Decreased RR & Vt
- Increase PaO2 & PaCO2, Decrease pH
- Pt sensorium-lethargic, sleepy confused
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Treatment of O2 induced hypoventilation
Decease level inspired oxygen
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Difference between high flow and low flow
- High flow supply patients entire inspired vol.
- Low flow systems part patients inspired vol.
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Qualifications low flow
- Vt: 300-700ml
- RR:<25pbm
- Regular vent pattern
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What is needed when charting medical gas
- Percent or flow of oxygen
- Type device utilized
- Duration oxygen use
- Doctors signature
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Low Flow devices
- Nasal Cannula
- Simple Mask
- partial Rebreather mask
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Nasal Cannula
- FiO2: 0.24-0.45
- Flow: 1-6 l/min
- Initial O2 device COPD, patients with stable RR and Vt
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Simple Mask
- FiO2: 0.40-0.55
- Flow: 6-10 l/min
- Set @ least 6 l/min to flush out exhaled CO2
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Partial Rebreather Mask
- FiO2: 0.60-0.65
- Flow: 6-10 l/min
- Has no one way flap valves
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Non-rebreather mask
- FiO2: 0.21-1.0
- has 3 one way valves
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Troubleshooting Non-rebreather mask
- If bag collapses increase flow
- If patient inhales & bag doesn't contract slightly
- mask not tight, seal mask
- Nonrebreathing valve stuck, replace mask
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Air entrainment mask/venturi mask
- Delivers precise FiO2 (ideal COPD)
- FiO2 will increases
- internal diameter of gas injector, increases
- increased resistance or obstruction downstream
- FiO2 deceased size of air entrainment ports increased
- Total flow increases as size of air entrainment port increases
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Briggs Adapter (T-piece)
- FiO2: 0.21-1.0
- See aerosol reservoir tubing during inspiration
- If aerosol disappears: increases flow, add more reservoir tubing, set up device provide more flow
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Aerosol masks, trach collars (mask) and face tents
- FiO2: 0.21-1.0
- RA wont enter as long as device flow exceeds inspiratory flow.
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Oxygen Hood
- Flow range 7-14 L/min
- Monitor Temp
- Overheating cause dehydration & apnea
- Underheating increase O2 consumption
- Amplifies surrounding noise level-use humidifier instead of nebulizer
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Mist tent, oxygen ten, croupette
- Peds
- Flow 0.40-0.50
- Monitor O2 near infants face
- O2 may layer w/higher FiO2 in lower layers
- Monitor infants fluid overload-weight gain.
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Incubator (isolette)
- Administer O2 to neonate by cannula, oxyhood,CPAP
- Provides humidity
- Ideal stable newborns
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Helium/Oxygen Therapy (He/O2)
- Pts increased airway resistance edema foreign body obstruction, partial vocal cord paralysis
- Decrease WOB delivers low density gas that can maneuver around obstructions.
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Calculate actual flow delievered
- 1.8=80/20 mix
- 1.6=70/30 mix
80/20 He/O 2, flow 10 l/min actual flow 18 l/min 10X1.8=18 L/Min
Administerd nonrebreathing mask
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Nitric Oxide (NO) Thearpy
- Relax smooth muscle, improves blood flow to alveoli
- Improves V/Q mismatch
- Decrease PVR & pulmonary pressures
- Improves oxygenation
- Results selective pulmonary vasodialtion
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Indications Nitric Oxide (NO) therpy
- Persistant pulmonary hypertension of Newborn
- Pulmonary Fibrosis
- Pulmonary Embolism
- Congenital Heart defects
- Chronic lung disease
- Heart & lung transplant
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What dose do you start nitric oxide?
Start does 20 ppm. Up to 80 ppm given w/out major side effects
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Cylinder equation
- (PSI) X tank Factor
- Liter Flow
- E cylinder: 0.28
- H cylinder: 3.14
- 2200 psi
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Massive leak occurs after removing flowmeter
- Try reinserting into wall
- Contact personal & supply O2 to patient
- Turn off zone valve
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Air Oxygen proportioners (blenders)
- Control mixing air & O2 to get specific FiO2
- Used w/non-rebreather mask to acheive precise FiO2.
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Calculate Total Flow
Flowmeter setting X Factor or FiO2 X factor
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Air Oxygen Entrainment Ratios
28
36
40
60
- 28 10:1
- 36 4:1
- 40 3:1
- 60 1:1
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